This study aimed to survey the current situation of polypharmacy and the characteristics of patients under diabetic treatment who prefer a once-weekly oral hypoglycemic agent (OHA). Among 520 outpatients who were receiving diabetic treatment in our hospital (age, 67±11 years; HbA1c, 7.0±0.8 %; Duration of diabetes, 14±9 years), 413 (79 %) were treated with multiple agents. A multivariate logistic regression analysis revealed that age (OR 1.03 [1.00-1.05]), diabetes duration (OR 1.05 [1.01-1.08]), HbA1c (OR 1.63 [1.15-2.31]), hypertension (OR 10.25 [5.15-20.41]), and the number of clinical departments (OR 1.93 [1.47-2.54]) were independent predictors of polypharmacy. A questionnaire survey revealed that 73 % of the patients preferred a once-weekly OHA, and that the patients who preferred a once-weekly OHA were significantly younger, were more often male, and used more types of medication for diabetes than those who did not prefer a once-weekly OHA. These findings suggest that polypharmacy is prevalent in diabetic patients. In addition, the percentage of patients who preferred once-weekly OHA was high. Furthermore, this patient group was younger, showed a male predominance, and used several types of diabetes medications.

Insulin-Degludec enables a flat and stable glucose lowering effect, despite its once-daily administration. Eighty-four diabetic patients on insulin therapy were assigned to one of two groups: in group D, the patients' long-acting insulin was changed to Insulin-Degludec; or group C, the patients' continued their current regimens (group C). We examined the effects of the treatment and the QOL of the patients. After 24 weeks of treatment, there was a significant difference in the reduction of the HbA1c level (group D, -0.60±0.65 %; group C, -0.35±0.55 %; p=0.03); this difference was remarkable when the patients were limited to those receiving intensive therapy. The QOL of each group was examined using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). After 24 weeks, Insulin-Degludec treatment improved the total score of satisfaction and treatment convenience, in comparison to standard therapy (group D+1.12±5.72, group C -2.31±6.55, p=0.03). In particular, Insulin-Degludec improved the satisfaction score (group D+0.85±4.27, group C -1.88±4.96, p=0.03). The scores for the questions on hyperglycemia or hypoglycemia did not differ between the two groups during the 24-week study period. The results showed that Insulin-Degludec was effective and that it improved the QOL of the patients.

Fulminant type 1 diabetes (FT1D) is characterized by the acute onset of insulin-deficient hyperglycemia and ketoacidosis due to the sudden destruction of pancreatic beta-cells within a few days. We report the case of a patient with FT1D in whom the blood glucose level was measured incidentally at 3 weeks prior to the diagnosis. A 63-year-old Japanese man presented to our hospital with a 14-day history of thirst, polyuria, and fatigue. The laboratory tests revealed severe hyperglycemia (651 mg/dL) with metabolic acidosis (arterial blood pH of 7.11) and ketonuria, indicating a diagnosis of diabetic ketoacidosis. Annual health checks had not detected hyperglycemia in the past. His ketoacidosis was controlled within 24 hours by an intravenous infusion of fluid and insulin. Although he had a 2-week history of thirst and polyuria, the clinical features were generally consistent with FT1D. The fasting blood glucose level was measured during his most recent annual health check, which was performed 3 weeks prior to the diagnosis of FT1D, and which was reported to be 183 mg/dL. This is the first reported case of FT1D in which hyperglycemia was detected 1 week before the onset of symptoms. Our findings seem to support the concept that there is variation in the rapidity of pancreatic beta-cell destruction during the development of FT1D.

The patient was a 76-year-old woman who had been diagnosed with diabetes when she was 75 years of age. Her blood glucose was initially well controlled by oral antidiabetic therapy. However, she was admitted to our hospital at approximately 6 months after her diagnosis because her casual blood glucose and HbA1c suddenly increased to 675 mg/dL and 11.9 %, respectively, and she also developed ketosis. An investigation to determine the cause of her blood glucose deterioration revealed pancreatic cancer. However, her anti-GAD antibody titer was also extremely high (124,000 U/mL), and she was diagnosed as simultaneously having slowly progressive insulin-dependent diabetes mellitus (SPIDDM). The development of SPIDDM in elderly patients is rare and there have only been a few reports about SPIDDM being diagnosed concurrently with pancreatic cancer. HLA genes were detected in the present patient. These genes are potentially related to disease resistance. It is possible that disease resistance HLA led to the simultaneous development of SPIDDM and pancreatic cancer in this elderly patient. Although pancreatic cancer and SPIDDM rarely occur simultaneously in elderly patients, the possible combination of a malignant tumor and type 1 diabetes mellitus (such as SPIDDM) should be considered if a patient's blood glucose control suddenly deteriorates during diabetes treatment.

The patient was a 32-year-old woman who had experienced amenorrhea since 20XX-5. She noticed her shoe size becoming larger in 20XX-3. She was diagnosed with diabetes mellitus in October 20XX-1 and was treated with insulin therapy, but the therapy was stopped in June 20XX. Physical weariness, excessive thirst, polydipsia, polyuria, manifested in mid-June with body weight loss (10 kg); she presented to our hospital in late June. Her blood glucose level was 362 mg/dL and she showed metabolic acidosis with a high anion gap (pH 7.29, PaCO2 30.4 mmHg, HCO₃^- 15.0 mmol/L, anion gap 18 mEq/L), as well as a urinary ketone body concentration of 3+. Her FT3 and FT4 levels were 2.04 ng/dL and 4.92 pg/mL, respectively. She was diagnosed with diabetic ketoacidosis and thyrotoxicosis. She experienced headache, which continued from the time of admission, and a sudden visual disturbance manifested on hospital day 4. Magnetic resonance imaging (MRI) of the pituitary revealed a mass in the sella turcica, with hemorrhage. She had high levels of growth hormone (3.20 ng/mL) and insulin-like growth factor-1 (373 ng/mL). These findings led to a diagnosis of acromegaly with pituitary apoplexy. She underwent surgery on the 9^th day of hospitalization.

A 28-year-old woman was diagnosed with type 2 diabetes mellitus at 17 years of age. Although she started to receive oral medicine and insulin therapy, she repeatedly discontinued the therapy under her own judgment. Eleven years later, she became pregnant, and in her seventh week of pregnancy, she was admitted to our hospital for blood glucose control and to evaluate her diabetic complications. Her HbA1c was 14.1 %, and she had bilateral proliferative retinopathy and macular edema. After admission, although she had achieved a fasting glucose level of approximately 150 mg/dL by intensive insulin therapy, maculopathy progressed, and her visual acuity worsened. She underwent abortion surgery in the eleventh week of pregnancy. After the abortion, the fasting and postprandial blood glucose levels were controlled to 120-140 mg/dL and 140-160 mg/dL, respectively, and the rapid progression of her retinopathy was stopped. We must recognize the importance of diabetes management for young women of child-bearing age to ensure that their health condition is maintained and successful pregnancy is achieved.

Despite great strides in pharmacotherapy for diabetes, there is increasing concern over the risk of hypoglycemia in diabetes patients receiving pharmacotherapy as they become older. This has prompted the Japan Diabetes Society (JDS) to initiate a survey on the current status of severe hypoglycemia in the clinical setting. In July 2015, after receiving approval from the JDS Scientific Survey/Research Ethics Committee, the JDS extended an invitation to executive educators, who represented a total of 631 healthcare facilities accredited by the JDS for diabetes education, to participate in the proposed survey. Among these educators, those who expressed their willingness to participate in the survey were sent an application form to obtain ethical approval from their hospitals. After receiving approval, they were asked to enter relevant clinical data (on an unlinked, anonymous basis) into a web-based registry. The current survey was fully funded by the JDS Scientific Survey/Research Committee. A case registry (clinical case database) was launched after collecting facility-specific information (healthcare facility database) from all of the participating facilities and after obtaining informed consent from all of the participating patients. The current survey, which defined severe hypoglycemia as "the presence of hypoglycemic symptoms requiring assistance from another person to treat and plasma venous glucose levels at the onset/diagnosis of disease or glucose levels that were clearly less than 60 mg/dL at presentation (capillary whole blood glucose, <50 mg/dL) ", was conducted between April 1, 2014 and March 31, 2015, During the study period, facility-specific information was collected from a total of 193 healthcare facilities with a total of 798 case reports collected from 113 facilities. (View PDF for the rest of the abstract.)